A radical prostatectomy can be a very difficult procedure because the surgeon cannot fully visualize the surgical site and work within the tight anatomical constraints. Complications from surgery can include impotence and incontinence due to sphincter damage. After the prostate has been excised, the urethra must be reconstructed to restore normal urinary function to the patient. Typically, the surgeon sutures the transected end of the urethral stump to the bladder neck. Occasionally, surgical complications occur at the anastomotic site such as the leakage of urine or, formation of strictures. The vulnerability of the site and the need to keep the lumen patent necessitates a means of support during the healing phase to achieve good anastomosis of the reconstructed urethra.
Radical prostatectomy patients require urinary drainage by an indwelling catheter following the procedure. The standard procedure for prostatectomy patients is to place a Foley drainage catheter at the time of surgery to be left in place for two to three weeks (healing period). While it is placed for drainage, the catheter also serves to keep the anastomotic site patent during the healing process. Although transurethral catheters can maintain urethral patency while providing post-surgical drainage of the bladder, there are disadvantages associated with their use. They are uncomfortable, resulting in a tendency for some patients to pull on the end of the catheter, which may dislodge it from the bladder. Occasionally, the retention balloon will deflate, permitting the catheter to migrate past the anastomotic site and out of the bladder. Another potential complication is that transurethral drainage catheters can become a pathway for pathogens and organisms that are carried or migrate from the skin surface through the urethra to the anastomotic site and the bladder. This may lead to infection and curtail the healing process. Furthermore, transurethral drainage catheters are not ideal for promoting good anastomosis of the surgical site because movement of the balloon may allow urine to leak around the catheter, which provides a suboptimal environment for healing. Foley catheters have only one or two drainage holes which may easily become obstructed by blood clot(s) resulting in poor or no drainage and anastomotic compromise. If the anastomotic site can be kept relatively dry, the likelihood of a good result is increased. Additionally, accidental jerking or other movement of the catheter can cause trauma to the bladder and/or anastomosis before the healing process is complete.